Subcontractor Form
Company Name
Address

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Phone Number

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Fax Number

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Contact Name

First
Last
Cell Number

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Email
Website
Nature of Work Performed
Years in Business
Employee Type
Social Economic Status
 Small Disadvantaged Business 
 HUBZone Samll Business 
 Veteran Small Business 
 Women Owned Business 
 Small Business 
 Service Disabled Veteran 

Equipment Fleet and Description

Prentice / Self Loaders
Dump Trucks
Tub Grinders
Bobcat / Skid Steer Loaders
Excavators
Generators
Wheel Loaders
Rubber Tire Loaders
Off Road Trucks
Dozers
Additional Equipment
and Quntity of Each

Insurance Requirements?

WORKER’S COMPENSATION: Coverage for all employees and statutory employees without any exemptions with minimum coverage to be $100,000.00 for each Accident, $500,000.00 for Disease-policy limit, $500,000.00 for Disease-each employee and/or Statutory limits for each coverage whichever is greater.

GENERAL LIABILITY with combined single limit of not less than $1,000,000.00, including contractual liability and completed operations coverage.

AUTOMOBILE/MOTOR VEHICLE: Combined single limit of not less than $1,000,000.

DANIEL’S TREE SERVICE, INC MUST BE ADDED AS AN ADDITIONAL INSURED ON ALL POLICY’S LISTED ABOVE.

Also additional insurance other then what is listed above may be required.
Can you meet all of these
insurance requirements?
 Yes 
 No 
Additional Information or Comments
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DTS, Inc.  326 East Darby Road Taylors, South Carolina 29687                Phone: (864) 244-5284                Fax: (864) 895-4807                Email: info@DTS-inc.org

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